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DETAILS photography and computerized microphotography hair count at tattooed alopecic sites. He prepares the scalp with an iodine-povidone prepara- tion. Next, 60cc of whole blood are drawn, utilizing the Smart PReP system (Harvest Technologies, harvesttech. com) to yield 7cc to 10cc of inactivated PRP. He then uses the Dermapen microneedling device in a stamp technique over the entire marked scalp with three passes, respectively at 0.5mm depth, 1.0mm depth and 1.5mm depth, so that the microinjuries reach all relevant dermal levels to elicit the maximal response. For pain reduction, he injects 0.1cc of 0.25% lidocaine without epinephrine into 60 to 70 sites on the scalp, spaced about 1cm apart. He then injects 0.1ml of the PRP into each of the sites in depot fashion by withdrawing a 23-gauge needle from the deep dermis to the superfi cial dermis— where most hair follicles are located—with slow injection using a tuberculin syringe. He follows the injections with LED light (660nm-950nm) exposure for 5 to 10 minutes. This is repeated at weekly intervals for up to six months. Patients are counseled to use a gentle, daily hair shampoo and conditioner. A three-day course of antibiotic and pain medications may be given, and minoxidil or fi nasteride use may be resumed three weeks after treatment with follow-up exams at three-month inter- vals for at least a year. Dr. Sasaki expects to see new hair growth about six months after the procedure, and patients have reported sat- isfactory to good results over the past two years. Although the optimal number of PRP treatments and intervals has yet to be determined, Dr. Sasaki recommends repeating the procedure on an annual basis. Dr. Lee also uses the Smart PReP system (Harvest Technologies, harvesttech.com) with 60cc of whole blood to derive PRP. The process is similar to Dr. Sasaki's in many respects, though the anesthesia protocol differs in that benzocaine 20%/lidocaine 6%/tetracaine 6% (BLT) is ap- plied only to clearly balding areas. The scalp is then covered for 30 minutes with plastic hair color protective caps. There have been no issues with lidocaine toxicity with such a lim- ited surface area, quantity and duration of exposure, despite improved absorption with plastic occlusion. Dr. Lee injects the PRP retrograde using a 30-gauge needle. He typically injects three or four 3cc syringes into clearly bald or balding areas. (Injections may traumatize healthy follicles, so Dr. Lee restricts injections to patently bald or balding areas.) The injections are spaced at 1cm intervals, totaling 30 to 50 treatment areas. As with any injection, risks include bleeding, bruising, tenderness and infection. Potential complications include cutaneous eruptions, post-traumatic hyperpigmentation, in- fl ammation, itching, hypertrophic scars and allergic reactions. With such a compelling premise, the application of PRP is becoming more and more prevalent—despite little evidence-based medicine—in widely diverse fi elds where the promotion of healing and tissue growth are benefi cial. These include dentistry, surgery, dermatology, aesthetics and hair growth. We believe that the use of PRP today is in its infancy and will grow exponentially in the coming years. Garry R. Lee, MD, is the medical director of Look Younger MD in Henderson, NV, and teaches for Allergan, Medicis, Dermapen and Air-Tite (MicroCannulas). Con- tact him at lookyoungermd.com. Gordon H. Sasaki, MD, FACS, is the founder of the Sasaki Advanced Aesthetic Medical Center in Pasadena, CA, and clinical professor in the Department of Plastic Surgery at Loma Linda University Medical School. Con- tact him at ghsasakimd@drsasaki.com. References: 1 Uebel CO, da Silva JB, Cantarelli D, Martins P. The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg 2006; 118:1458-66. 2 Rinaldi F, Sorbellini E, Coscera T. The role of platelet rich plasma to control anagen phase: Evaluation in vitro and in vivo in hair transplant and hair treatment. Int J Trichol 2011; 3:S14-5. 3 Kang JS, Zheng Z, Choi MJ, Lee SH, Kim DY, Cho SB. The effect of CD34+cell-containing autologous platelet-rich plasma injection on pattern hair loss: A preliminary study. J Eur Acad Dermatol Venereol 2014; 1:72-78. Dr. Sasaki expects to see new hair growth about six months after the procedure, and patients have reported satisfactory to good results. Garry R. Lee, MD, performing depot injections of PRP to the scalp. PHOTO COURTESY OF GARRY R. LEE, MD 32 SEPTEMBER 2014 | Med Esthetics